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P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.01-008 - Second Line Erlotinib for NSCLC Patients with EGFR Mutation: Our Experience (ID 214)
09:30 - 17:00 | Author(s): S. Crvenkova
As regards lung cancer patients who have relapse on platinum-based chemotherapy, there is a significant need for effective, well-tolerated treatment. Targeted agents such as orally active epidermal growth factor receptor EGFR tyrosine kinase inhibitor TKI (Erlotinib-Tarceva) and (Gefitinib-Iressa) offered a new therapeutic approach. Discovering of somatic EGFR mutations in some patients with NSCLC was a very significant breakthrough in the understanding of this disease. EGFR mutations occur almost within exons 18-21 of the gene of the receptor. The aim of this study was to evaluate tumor response, QoL and adverse effects of erlotinib, as a second line therapy for patients with EGFR mutation in NSCLC, after failure on previous first line therapy.
During the year 2010-2011, 5 patients were enrolled in this study for testing EGFR mutations, after conditions for testing were created in Macedonia. We screened 5 patients for EGFR mutations by direct sequencing of axons 18 to 21, by retrospective analyzed their previous biopsy samples. Three of the patients were men and two of the patients were women. Previous smokers were two of males and one male and both female were never-smokers. All of the patients who were enrolled in the study were with histological proven adenocarcionoma. Patients started with erlotinib 150 mg, one tablet per day, after failure on previous first line platinum based chemotherapy, with or without surgery and radiotherapy. Assessment of tumor response was according RECIST criteria on the follow-up visits every 4 weeks. We analyzed tumor response from the beginning with erlotinib until tumor progression or detected severe toxicity. Assessment was performed only for those patients with EGFR mutations. Assessment of QoL was performed by patient’s subjective answers, as subjective improvement and without subjective improvements. Adverse effects were performed according to WHO criteria.
Tissue was available for all 5 cases, two (40%) of which were found to harbor an EGFR mutation, identified axon 19 deletions. The both two patients responded to therapy. Complete response was seen in female patient for 37 months. Progressive disease was reason to stop with erlotinib after 37 mounts and start with third line therapy. Partial response in male patient was assessed for 30 mounts and is still in follow up. This patient is still alive with good condition. The two patients reported subjective improvements during treatment with erlotinib. Skin rash was grade 2-3, and diarrhea was grade1-2. Both patients complained for hair loss, but without complete alopecia.
Considering our clinical results, we recommend target therapy with erlotinib for patients with NSCLC and EGFR mutations as a second line treatment. Our excellent results encouraged to require prospective tissue procurement for all patients in Macedonia. This may in fact require a shift in diagnostic practice, from the current emphasis on fine-needle aspiration, which often provides insufficient material for molecular analysis, to obtaining more substantial biopsies and to provide this treatment as a first line for selected patients.
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